WilmingtonDERecruiter Since 2001
the smart solution for Wilmington jobs

Staff VP Program Integrity Provider Audit (Reimbursement Strategy)

Company: Anthem, Inc
Location: Wilmington
Posted on: March 28, 2020

Job Description:

Staff VP Program Integrity Provider Audit (Reimbursement Strategy) - PS34915Location: United StatesNewRequisition #: PS34915Post Date: 16 hours agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Preferred Office Locations:Norfolk or Virginia Beach, VAIndianapolis, INMason, OHAny Anthem office locationThe Staff VP of Provider Audit is a leadership role responsible for managing the Provider Audit department within the Program Integrity division of Anthems Diversified Business Group (DBG). The successful candidate will have extensive business transformation and organizational change experience, as well as people management skills to be equipped to work with the Vice President of Program Integrity along with peer Staff Vice Presidents and associates to advance the following business objectives:

  • Provide leadership and oversight to deliver a 200%+ improvement in cost of care savings within 12-18 months, while improving the operating structure: 1. Implement programs to elevate productivity and standardize audits 2. Identify and evaluate new and existing concepts and opportunities to deliver cost of care savings 3. Create a performance-based culture of delivery excellence, financial transparency and team accountability 4. Hiring the right mix of talent to scale the Provider Audit team to meet growing demand and potential commercialization effort, such as building out a BPO service.
  • Cultivate and manage demand from Anthem health plans, national accounts, and other clients to deliver value through services: 1.Develop an understanding of health plan and national account needs to craft relevant Provider Audit services 2. Work with Product & Efficiency to ensure emerging needs are addressed with Information Technology solutions and Business Services 3. Support commercialization initiatives to bring Provider Audit solutions to market overtime to serve both Anthem and other clientsParticipates in developing strategic direction for clinical reimbursement programs to foster elimination of fraud, waste, and abuse. Defines audit concepts to meet grow incremental cost of care value by 20-30% each year. Oversees program design and workflow to operationalize and enhance management of overpayments to increase program savings.Key Responsibilities
  • Manage the Provider Audit department to ensure financial and operational performance goals are achieved.
  • Influence clinical policies to support program implementation and adoption. Drive strategic direction of the Program Integrity Medical Director team and ensure strong partnerships with medical management.
  • Create a supportive culture that embraces new technologies and continuous process improvement.
  • Elevate performance for existing concept execution through standardization of business practices.
  • Streamline new concept creation to support effective expansion of Provider Audit to address emerging health plan needs.
  • Create and implement business plans to support scaling the departmentRequired:
    • BA/BS degree.
    • 10+ years related experience in broad based analytical, managed care payer or provider environment; demonstrated clinical thought-leadership experience including auditing experience.
    • Excellent leadership, financial and operational skills required.
    • Travel up to 15% - 20%.Preferred:
      • Ten years of management experience with strong organizational change management background and provider audit experience or clinical documentation improvement experience.
      • Any combination of education and experience which would provide an equivalent background.
      • MBA preferred. M.D. or D.O.
      • Board certification approved by the American Board of Medical Specialties a plus.Desired Experience/Skills:
        • Experience managing Provider Audit or Clinical Documentation Improvement (CDI) departments.
        • Demonstrated ability to identify new programs and influence clinical policy to enable program success.
        • Decisive, quick on your feet, strong executive presence with the ability to drive operational performance and new program launches.
        • Demonstrated capacity and track record of acting with a sense of urgency to tactically evaluate, implement programs and initiatives and work with a variety of organizational leaders to build consensus.
        • Sound analytical thinking, financial planning acumen, prioritization, and process orientation and execution skills.
        • Collaborative mindset to work with cross-functional teams to develop solution-oriented products and partnerships.
        • Strong communication skills, with ability to develop compelling written communications, term sheets and presentations.
        • Proven experience managing multiple, competing priorities while flawlessly executing on driving deliverables and operational tasks.
        • Project management and lean six sigma experience preferred, but not required.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran

Keywords: Anthem, Inc, Wilmington , Staff VP Program Integrity Provider Audit (Reimbursement Strategy), Executive , Wilmington, Delaware

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Facility and Grounds Manager
Description: Job Summary: The Facility and Grounds Manager will perform, coordinate, or supervise all areas of building, property and grounds maintenance. Works with Church Administrator and Chair of the Property (more...)
Company: Mount Vernon Unitarian Church
Location: Silver Spring
Posted on: 04/5/2020

Director of Operations
Description: The Director of Operations manages,
Company: TeamWork Online
Location: Trenton
Posted on: 04/5/2020

Director - eDiscovery Technology
Description: The Director is generally autonomous in their oversight and active management for a Technology program and/or practice area and most often reports directly to a Senior Director or Vice PresidentEssential (more...)
Company: FINRA
Location: Rockville
Posted on: 04/5/2020


Director, Membership and Communications
Description: Description: br br This position is responsible for effectively communicating the member-value proposition to ASHA Certified members in such a way that they understand and appreciate the value of (more...)
Company: American Speech-Language-Hearing Association
Location: Rockville
Posted on: 04/5/2020

Assisted Living Community Relations Director
Description: Summary: br br The Assisted Living Community Relations Director is responsible for building and growing census by developing referral relationships with existing customers and developing new business (more...)
Company: Artis Senior Living
Location: Bethesda
Posted on: 04/5/2020

Food Service Director
Description: Lancaster, PA, USA We are seeking a Food Service Director for our skilled nursing facility The Barre Mansion Care in Lancaster, PA br br As a Food Service Director you are responsible to direct, (more...)
Company: The Barre Mansion Care
Location: Lancaster
Posted on: 04/5/2020

Professor, Precision Health; and Director, Value Evidence and Outcomes
Description: As part of a significant expansion of its innovative and patient-centered programs in genomics and precision health, Geisinger has launched a national initiative, based in the Washington, DC area. Geisinger (more...)
Company: America's Health Insurance Plans (AHIP)
Location: Bethesda
Posted on: 04/5/2020

Shift Manager
Description: Want to be part of a team and an opportunity to grow -- We are seeking career-minded, motivated individuals with excellent interpersonal skills and the ability to work
Company: Wendy's
Location: Levittown
Posted on: 04/5/2020

Fraud and Claims Management Initiative and Program Management Manager
Description: Job DescriptionImportant Note: During the application process, ensure your contact information email and phone number is up to date and upload your current resume when submitting your application for (more...)
Company: Wells Fargo
Location: Wilmington
Posted on: 04/5/2020

Assistant Maintenance Manager
Description: Unitex is experiencing unprecedented growth Due to this growth, we are seeking an Assistant Maintenance Manager for our industrial laundry plant located in New Brunswick, NJ. Responsibilities include: (more...)
Company: Unitex
Location: New Brunswick
Posted on: 04/5/2020

Log In or Create An Account

Get the latest Delaware jobs by following @recnetDE on Twitter!

Wilmington RSS job feeds